Abstract

Background

Increasing evidence suggests that use of augmented visual feedback could be a useful
approach to stroke rehabilitation. In current clinical practice, visual feedback of
movement performance is often limited to the use of mirrors or video. However, neither
approach is optimal since cognitive and self-image issues can distract or distress
patients and their movement can be obscured by clothing or limited viewpoints. Three-dimensional
motion capture has the potential to provide accurate kinematic data required for objective
assessment and feedback in the clinical environment. However, such data are currently
presented in numerical or graphical format, which is often impractical in a clinical
setting. Our hypothesis is that presenting this kinematic data using bespoke visualisation
software, which is tailored for gait rehabilitation after stroke, will provide a means
whereby feedback of movement performance can be communicated in a more meaningful
way to patients. This will result in increased patient understanding of their rehabilitation
and will enable progress to be tracked in a more accessible way.

Methods

The hypothesis will be assessed using an exploratory (phase II) randomised controlled
trial. Stroke survivors eligible for this trial will be in the subacute stage of stroke
and have impaired walking ability (Functional Ambulation Classification of 1 or more).
Participants (n = 45) will be randomised into three groups to compare the use of the visualisation
software during overground physical therapy gait training against an intensity-matched
and attention-matched placebo group and a usual care control group. The primary outcome
measure will be walking speed. Secondary measures will be Functional Ambulation Category,
Timed Up and Go, Rivermead Visual Gait Assessment, Stroke Impact Scale-16 and spatiotemporal
parameters associated with walking. Additional qualitative measures will be used to
assess the participant’s experience of the visual feedback provided in the study.

Discussion

Results from the trial will explore whether the early provision of visual feedback
of biomechanical movement performance during gait rehabilitation demonstrates improved
mobility outcomes after stroke and increased patient understanding of their rehabilitation.